Group Practice Size Consolidation in Emergency Medicine.

STUDY OBJECTIVE: Practice consolidation is common and has been shown to affect the quality and cost of care across multiple health care delivery settings, including hospitals, nursing homes, and physician practices. Despite a long history of large practice management group formation in emergency medicine and intensifying media attention paid to this topic, little is known about the recent practice consolidation trends within the specialty. METHODS: All data were obtained from the Centers for Medicare and Medicaid Services Physician Compare database, which contains physician and group practice data from 2012 to 2020. We assessed practice size changes for both individual emergency physicians and groups. RESULTS: From 2012 to 2020, the proportion of emergency physicians in groups sized less than 25 has decreased substantially from 40.2% to 22.7%. Physicians practicing in groups of more than or equal to 500 physicians increased from 15.5% to 24%. CONCLUSION: Since 2012, we observed a steady trend toward increased consolidation of emergency department practice with nearly 1 in 4 emergency physicians nationally working in groups with more than 500 physicians in 2020 compared with 1 in 7 in 2012. Although the relationship between consolidation is likely to draw the most attention from policymakers or payers seeking to negotiate prices in the near term and advance payment models in the long term, greater attention is required to understand the effects of practice consolidation on emergency care.

A Retrospective Study Analyzing Opioid Prescription Practices in Hand Surgery from 2013 to 2019.

Background: The potential for opioid prescription medication addiction and abuse has been a growing concern in healthcare. It is not uncommon for hand surgery patients to be overprescribed opioid medication for postoperative pain management. The objective of this study was to characterize changes in opioid prescription practices of hand surgeons treating Medicare Part D patients from 2013 to 2019. Methods: A retrospective analysis of Medicare Part D prescriber data from 2013 to 2019 was conducted. This database provides information on drugs paid for under the Medicare Part D Prescription Drug Program. For each prescriber and medication, the dataset includes the total number of prescriptions dispensed (original prescriptions and number of refills), and total medication cost. Results: In 2013, the 10 most common medications prescribed totaled 114,409 prescriptions, with 89,701 (78.4%) opioid prescriptions. In 2019, the 10 most common medications prescribed totaled 164,955 prescriptions, with 109,665 (66.5%) opioid prescriptions. Although total opioid prescriptions dropped, there was a 22% increase in the total number of prescriptions written. The two most common medications prescribed, hydrocodone-acetaminophen and oxycodone-acetaminophen, totaled 75,796 in 2013, compared with 76,518 in 2019. The overall number of prescriptions for nonsteroidal anti-inflammatory drugs increased by 157%, and the percentage of total opioids prescribed declined by 7.9%. Conclusions: The increase in total opioid prescriptions from 2013 to 2019 by hand surgeons in the Medicare Part D Prescription Drug Program lags behind the recommended shift to nonopioid pain management. The reasons for the overall rise in prescriptions deserve further exploration.

A 20-Year Analysis of Medicare Reimbursement for Abdominal Wall Reconstruction (2000 to 2020).

BACKGROUND: The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for 30 abdominal wall reconstruction surgical procedures over a 20-year period (2000 to 2020). METHODS: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was used for each of the 30 included current CPT codes, and reimbursement data were extracted. Monetary data were adjusted for inflation to 2020 U.S. dollars using changes to the United States consumer price index. The R 2 values for the average annual percentage change and the average total percentage change in reimbursement were calculated based on these adjusted trends for all included procedures. RESULTS: After adjusting for inflation, the average reimbursement for all procedures decreased by 17.1% from 2000 to 2020. The greatest mean decrease was observed for CPT code 49568 (the implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of débridement for necrotizing soft-tissue infection, -34.4%). The only procedure with an increased adjusted reimbursement rate throughout the study period was CPT code 20680 (+3.9%). From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 0.85% each year, with an average R 2 value of 0.78, indicating a stable decline throughout the study period. CONCLUSIONS: Reimbursement rates are declining when adjusted for inflation. Increased awareness of these trends is helpful to maintain access to optimal abdominal reconstruction care in the United States.

A Comparative Analysis of the Common Injections Performed by Plastic Surgeons: 2012 and 2019.

Background: Plastic surgeons regularly perform injections for both cosmetic and functional purposes. This article examines the most common injections utilized by plastic surgeons under Medicare and how their usage and billing has changed between 2012 and 2019. Methods: Using the earliest and latest data available on the Centers for Medicare and Medicaid Services' Provider Utilization and Payment Data File, we first determined Healthcare Common Procedure Coding System injection codes most billed to Medicare in 2012 and 2019. The number of services, amount of Medicare beneficiaries, and reimbursement rates were collected and analyzed for each Healthcare Common Procedure Coding System code from the Provider Utilization and Payment Data File for years 2012 and 2019. We compared the change in reimbursement rate for each injection to the rate of inflation in US dollars over the same period. Results: The unadjusted Medicare reimbursement rate for eight included injection types increased an average of 31.63% during the study period. This was not significantly different from the rate of inflation during the same period (+11.33%, P = 0.311). When all Medicare reimbursement data were adjusted for inflation to 2019 dollars, the average percentage change in reimbursement for all included injections in this study increased by 17.58% from 2012 to 2019. Conclusions: The findings from our study suggest that injections administered by plastic surgeons appear to be unique in their general stability in reimbursement rates as compared to rates in other fields. Further research should be performed to better understand the driving factors for usage and reimbursement changes.

An Analysis of Medicare Reimbursement for Neurosurgeon Office Visits: 2010 Compared to 2018.

BACKGROUND: Trends in Medicare billing and procedural reimbursement for outpatient office visits remain unclear within the field of neurosurgery. OBJECTIVE: To analyze financial trends of neurosurgeon reimbursement for Medicare office visits in 2010 compared to 2018. METHODS: The 2010 and 2018 physician/supplier files from the Centers for Medicare and Medicaid Services website were utilized. All payments submitted by neurosurgeons (provider ID 14) were included. Trends in office visit Current Procedural Terminology codes 99201 to 99205 and 99211 to 99215 were analyzed. RESULTS: Neurosurgeons billed for 1 109 979 office visits (463 611 h) in 2010 and Medicare denied 63 704 payments (totaling $11 205 283). Neurosurgeons billed for 1 189 046 office visits (508 526 h) in 2018 and Medicare denied 57 048 payments (totaling $15 103 879). This is a 7.1% increase in total neurosurgery office visits billed to Medicare, 9.7% increase in total office hours, and 34.8% increase in the payment amounts denied over 8 yr. Furthermore, after adjusting for inflation, the average amount paid to physicians by Medicare decreased by 8.3% per office visit. Additionally, Medicare paid 36.1% of the total neurosurgeon submitted charge amount for all office visits in 2010 but paid only 27.8% in 2018 (-8.3%). CONCLUSION: Neurosurgeons are performing more office visits and billing for more time with patients. Meanwhile, Medicare has been paying physicians less per office visit, denying higher amounts of payments and reimbursing a decreasing percentage of submitted charges for office visits. An understanding of these trends is necessary to ensure continued equity and quality access to neurosurgical care in the United States.

Parental Self-Assessment of Behavioral Effectiveness in Young Children and Views on Corporal Punishment in an Academic Pediatric Practice.

This article assesses parental confidence and current behavioral techniques used by mostly African American caregivers of young children in an urban Southeastern setting, including their use and attitudes toward corporal punishment (CP). Two hundred and fifty parental participants of children aged 18 months to 5 years completed a survey on factors affecting their behavioral management and views on CP. Statistical analysis included χ2 test and logistic regression with confidence interval significance determined at P <.05. Significant associations of CP usage were found in parents who were themselves exposed to CP and parental level of frustration with child disobedience. A total of 40.2% of respondents answered that they had not received any discipline strategies from pediatricians and 47.6% were interested in receiving more behavioral strategies. Clear opportunities exist for pediatricians to provide information on evidence-based disciplinary techniques, and these discussions may be facilitated through the creation of a No Hit Zone program in the pediatric practice.